PubMed · 10368546
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1999. Progesterone.. https://pubmed.ncbi.nlm.nih.gov/10368546/
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PURPOSE: Current adjuvant therapies have improved survival for premenopausal patients with breast cancer but may have short-term toxic effects and long-term effects associated with premature menopause. PATIENTS AND METHODS: The Zoladex Early Breast Cancer Research Association study assessed the efficacy and tolerability of goserelin (3.6 mg every 28 days for 2 years; n = 817) versus cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy (six 28-day cycles; n = 823) for adjuvant treatment in premenopausal patients with node-positive breast cancer. RESULTS: Analysis was performed when 684 events had been achieved, and the median follow-up was 6 years. A significant interaction between treatment and estrogen receptor (ER) status was found (P =.0016). In ER-positive patients (approximately 74%), goserelin was equivalent to CMF for disease-free survival (DFS) (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.84 to 1.20). In ER-negative patients, goserelin was inferior to CMF for DFS (HR, 1.76; 95% CI, 1.27 to 2.44). Amenorrhea occurred in more than 95% of goserelin patients by 6 months versus 58.6% of CMF patients. Menses returned in most goserelin patients after therapy stopped, whereas amenorrhea was generally permanent in CMF patients (22.6% v 76.9% amenorrheic at 3 years). Chemotherapy-related side effects such as nausea/vomiting, alopecia, and infection were higher with CMF than with goserelin during CMF treatment. Side effects related to estrogen suppression were initially higher with goserelin, but when goserelin treatment stopped, reduced to a level below that observed in the CMF group. CONCLUSION: Goserelin offers an effective, well-tolerated alternative to CMF in premenopausal patients with ER-positive and node-positive early breast cancer.
HISTORY AND CLINICAL FINDINGS: A 59-year-old woman was examined because of weight gain, increasing fatigue and secondary amenorrhoea, which occurred after a complicated delivery at age 18. The finding of an increased TSH concentration was initially considered as primary hypothyroidism and substitution therapy was commenced. Because of the concomitant secondary amenorrhoea the patient was referred for additional endocrinological investigations. INVESTIGATIONS: Biochemical analysis confirmed the increase in TSH concentrations, and revealed a gonadotropin deficiency, a decrease in IGF-I concentration and a free urinary cortisol concentration at the lower end of the normal range. Dynamic testing of pituitary function (insulin tolerance test) confirmed a severe growth hormone deficiency and partial secondary adrenal insufficiency. An MRI study of the pituitary showed an empty sella with some remaining pituitary tissue at the bottom of the sella. DIAGNOSIS, TREATMENT AND CLINICAL COURSE: The laboratory findings of pituitary insufficiency with an empty sella on MRI scan suggested Sheehan's syndrome despite an increase in thyrotropin level. Pituitary replacement therapy was started with hydrocortone, combined estrogens and progesterone in addition to levothyroxin, which considerably improved clinical symptoms. CONCLUSION: A history of secondary amenorrhoea after a complicated delivery including significant bleeding or septic complications suggest Sheehan's syndrome, which can result in partial or complete panhypopituitarism. In such circumstances the pituitary hormone levels are usually reduced. TSH concentrations, however, may be increased.
OBJECTIVE(S): To evaluate the effects of two doses of medroxyprogesterone acetate (MPA) on uterine leiomyoma sizes and on uterine bleeding pattern in postmenopausal women treated with oral hormone replacement therapy (HRT). STUDY DESIGN: Thirty natural postmenopausal women affected by uterine leiomyomas were enrolled and treated with oral micronized estradiol (E(2)) at dose of 2 mg per day, and randomized to receive in association MPA at dose of 2.5 mg daily (group A) or of 5 mg daily (group B). At the beginning of the study and after 1 year of treatment, uterine leiomyomata dimensions were measured using transvaginal ultrasonography (TV-USG). The subjects were instructed to note on a daily dairy the number and severity of abnormal uterine bleeding (AUB) episodes. RESULTS: After 1 year of therapy, a significant changes in mean uterine leiomyomas size was observed in the group treated with higher dose of MPA. No significant differences in uterine bleeding were detected between the two groups. CONCLUSION(S): In postmenopausal women with uterine leiomyomas, it is necessary to use the minimal efficacious dose of progestin during HRT because of a higher risk to increase the tumors dimensions.